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002-1020-90-500
Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Wisconsin Safety and Building Division Sanitary Permit No: INSPECTION REPORT 592123 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, 5.15.04 (1)(m)]. 2773465 Permit Holder's Name: City Village Township Parcel Tax No: David & Michele Lee TOWN OF BALDWIN 002-1020-90-500 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 10.29.16.141 E TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. r Septic QiS 1 'r.~ 7,S Benchmark Dosing So Alt. BM LC / _ ctq. Z LJ Bldg. Sewer l~/rY I~IZ g Holding _ St/Ht Inlet 1, S y0 St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. ent Air Intake ROAD Dt Inlet 1 Septic / ` ! A- 3 3 Dt Bottom / ` , s -V-7 Dosing A) 33 3 1 Header/Man. Z . Ian Aeration Dist. Pipe Z /d(• O(p Bot. System -3, 417 /453 Holding =----7- :1.5, ~ /6Z • 1 G3 PUMP/SIPHON INFORMATION Final Grade ,1• Z 5 (/c Manufacturer j GP ^and St Cover Go Aj. if Model Number TDH Lift Friction Loss System Hea I!5`7 TDI~41. ~P t e OiR 465 16Z ~j Forcemain I Len th 7o Dia. Z Dist. to Weu WA SOIL ABSORPTION SYSTEM r All epth BEDITRENCH Width d ) Length No. rench PIT DIMENSIONS No. Of Pits Inside Dia._ Liquid D- DIMENSIONS /Q i15 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type tern: , C i AiA Iv .4 UNIT Model Number: o® DISTRIBUTION SYSTEM Header/Manifold . / IPD iipe str (ibution ♦ x HoZ,;z ize x Hole Spacing Ver]t~to Air I take 73 U s) ~j . Mu Dia Spacing 3 ~ J ~OJ Length ~'V' Dia ~.ZS Length ~3 S0 1 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only " Mulbkj~ Depth Over Depth Over xx Depth of xx Seeded/Sodded r Bed/Trench Center ' - 3 Bed/Trench Edges *1111, Topsoil Yes No s No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:-f~~Z~~ Inspection #2: Y^ Location: 1077 240TH ST L,t C41 AOi- ~ ; 1.) Alt BM Description 2.) Bldg sewer length = G wt&b - amount of cover = S S Irv. Plan revision Required? ❑ Yes /No '1 Use other side for additional information.Cert. No. Date Insepctots Sign ure SBD-6710 (R.3/97) Plot Plaofor Site and ,Soil' Pvrala~€i Page 8 of$ Property Owner -L')Auia u t t, tmsi~~ ~ i-es -1 40ft. L gai Des tlon MW 1/4 ar s! 0 es g. S, 0L (except wlere noted) TZgW}~ T~~A'JAJ _ =Backhoe'Pit 93 Adm!~Wori* R f~ d hlw-fw PI.- -SAM r b Z-t. g F 1- e 5 ~ X 45, q~ 00 ~ y Ae= l o hno Teti ~ ~ WJF-LL--TO 2-6, -Tos Site Locadoo. sO DR 1N = L~ N R Big xyv. ~ •rj 4O y~ County Safety and Buildings Division C u11~ 19 201 W. Washington Ave., P.O. BOX 7162 Sanitary Permit Number (to be filled in by Co.) p s s Madison, WI 53707 62 ado ~ 01y, Cou,QP ENT 1 ~ ~ ~ J NIA D~ sT, Sanitary Permit Applicatic,8RKESSp~wS8R State Trans action Number/ in accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate govemmenu„ t • t✓~ is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Departmebt of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04 1 m , Stats. ,.l • f / f S 1. Application Information - Please Print All Information /jj 0 7 V Property Owner's Name Parcel # v( A tit-E LSE ©0-z- ®ze) Property Owner's Mailing Address Property Location Lit cl j , fit{ Q t V~'t Govt. Lot City, State Zip Code Phone Number tit W V, Section -71Z---1bV-0Y Z ,(Circle one) T N; R E orO H. Type of Building (check all that apply) / Lot ❑ 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name 15 ❑ Public/Commercial - Describe Use Block ❑ City of D J'S tth-/*%, 11 State Owned - Describe Use CSM Number 9Z6,3!5 ❑ Village of k Z -Town of &I-f) 1,0/ /6 4 a III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. )(New System ❑ RePlacement System 11 Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain) B List Previous Permit Number and Date Issued / El Permit Renewal Q. Permit Revision El Change of Plumber 11 Permit Transfer to New Before Expiration Owner IV. Type ofPOWTS S stem/Com onentlDevice: Check all that apply) A d ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil X Mound < 24 in. of suitable soil / ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Treat ent Area Information: Design Flo w (gpd) Design Soil Application Rate(gp Dispersal Area Requir (sf) Dispersal Area Pr os f) System Elevation / q5t VI. Tank Info Capacity in otal 4 of Manufacturer Gallons Gallons Units P New T anks Existng Tanks w ~ V ~ ~o ~ ~ro U 2 i~ Septic or Holding Tank i.wO r t f/v I Dosing Chamber w^ ' VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumb 's Signature MPRWPIM Number Business Phone Number I e Plumber's/Address (Street, City, State, Zip Code) VIII. _County/Departrnent Use Only proved ❑ Disa Permit Fee Date sued rr Issuing t Sn Reason for Denial / A 4L:;/;~ IX. Cond40 easons for Disapproval J t. septic taieh, effluent flk@,r id 31 /(A disper ,i cell must afl be seivics_ ! maiMaires ✓ ~tti S' t - Wl~ as per rnaragement plan provided byby plumber. 2. All setback requirements must be maintE.ined as per applicable coda / crdinanrM. Attach to complete plans for the system and submit to the County only on paper not less than 8 U2 x 11 inches in size SBD-6398 (R 11/11) y l`oti7.jf\f~ DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL STE 150 GREEN BAY WI 54304-5211 S Contact Through Relay P I http://dspswi.gov/programs/industry-services wvvw.wisconsiri.gov Scott Walker, Governor Dave Ross, Secretary C September 13, 2016 APPROV OUST ID No, 224832 ATTY. POWTSInspector DEPT OF SAFE PROFESSIONAL MARY JO HUPPERT ZONING OFFICE DI I 'UN OF IN ~ T HOLLISTERS SOIL TESTING & DESIGN ST CROIX COUNTY SPIA 28497 KING ARTHURS 1101 CARMICHAEL RD DANBURY WI 54830 HUDSON WI 54016-7708 CONDITIONAL APPROVAL SEE PLAN APPROVAL, EXPIRES: 09/13/2018 Identification Numbers Transaction ID No. 2773465 SITE; Site ID No. 828674 David and Michele Lee Please refer to both identification numbers, 1077 240TH St above, in all correspondence with the agencv. Town of Baldwin St Croix County NW1/4, NW1/4, S10, T29N, RI 6W FOR: Description: Mound System (3 Bedrooms - New Construction) Object Type: POWTS Component Manual Regulated Object ID No.: 1623126 Maintenance required; 450 GPD Flow rate: 18 in Soil minimum depth to limiting factor from original trade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component Manual - Ver. 10, SBD-10706-P (N.01/01, R, '10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 1.01.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbhig in the state unless licensed to do so by the Department per x.145.06, stars. The following conditions shall be met during construction or installation and prior to occupancy or use: • Recommend to insulate and protect force main under field road. • Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site. • With new construction; it is recommended not to activate the pump in the dose tank until the tanks are pumped prior to homeowner occupancy, • Wastewater generated from contractors cleaning of equipment and tools and/or left over construction products shall not be discharged into the drains discharging to the private onsite wastewater treatment system (POWTS). Waste generated shall be properly disposed of on-site or off site, • Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area. All loose organic material to be removed from mound area. • Divert surface water from POWTS Area. • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a li4- inch wire, MARY 10 HUPPER'T Pace 2 9/13!2016 the site is too wet to prepare. If it crumbles. site preparation can proceed. If' the site is too wet to prepare. do not proceed until it dries. • All piping shall conform to SPS Table 384.20-3 and SPS Table: 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Well setbacks to meet chs. NR 811 & 812 • Tank Installation to follow all manufacture's recommendations. • Verify property line(s) prior to installation. • SPS 383.54(I)(e) The management plan for a PO WTS shall specifically address the servicing mechanics of an aerobic or anaerobic treatment tank or a holding tank where either of the following conditions exist. 1. The bottom of the tank is located more than 15 feet below the elevation where the servicing pad is located. 2. The bottom of the tank is located more than 150 feet horizontallv from where the servicing pad is located. • Pump Floats to be set and verified per approved plan env changes may result in pump resizin~ to meet TDH and GPM Specifications. • Areas that are occupied with rock fragments, tree roots, stumps and boulders reduce the amount of soil available for proper treatment. If no other site is available, trees in the basal area of the mound must be cut off at ground level. A larger fill area is necessary when any of the above conditions are encountered, to provide sufficient infiltrative area. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a. copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required S 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, 'Tim Vander Leest Please Include a Copy With Your Private Sewage Plan Reviewer , Division of Industry Services Payment Submittal. (920)492-2214, Monday - Friday 6 am To 3:30 pm WiSMART code: 7633 tim.vanderleest,c ~~-isconsirr.gov MARY JO HUPPERT Page 2 9/13/2016 the site is too wet to prepare. If it crumbles site preparation can proceed If the site is too wet to prepare do not proceed until it dries. • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Well setbacks to meet chs. NR 811 & 812 • Tank Installation to follow all manufacture's recommendations. • Verify property line(s) prior to installation. • SPS 383.54(1)(e) The management plan for a PO'~~ TS snail spcci2icai % address the se,-vicing mechanics of an aerobic or anaerobic treatment tank or a holding tank where either of the following conditions exist: 1. The bottom of the tank is located more than 15 feet below the elevation where the servicing pad is located 2. The bottom of the tank is located more than 150 feet horizontally from where the servicing pad is located • Pump Floats to be set and verified per approved plan Anv changes may result in pump resizina to meet TDH and GPM Specifications. • Areas that are occupied with rock fi•agments, tree roots, stumps and boulders reduce the amount of soil available for proper treatment. If no other site is available, trees in the basal area of the mound must be cut off at ground level. A larger fill area is necessary when any of the above conditions are encountered, to provide suf icient infiltrative area. O-Amer Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the PO WTS. Sincerely, Fee Required S 250.00 z~ This Amount Will Be Invoiced. When You Receive That Invoice, Tim Vander Leest Please Include a Copy With Your Private Sewage Plan Reviewer, Division of Industry Services Payment Submittal. (920)492-2214 Monday - Friday 6 am To 3:30 pm WiSMART code: 763 33 tim.vanderleestnwisconsin.gov MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE 'LL Y Project Name: DAVID L. & MICHELE K. LEE J'Y Owner's Name: (same)°4 V yERVICF Owner's Address: 304 6th Avenue Baldwin, WI 54002 0 Legal Description: NW 1/4 of the NW 1/4, Sec. 10, T29N, R16W Township: Baldwin County: St. Croix Subdivision Name: NA Lot Number: 5 Block Number: NA Parcel I.D. Number: 002 - 1020 - 90 - 500 Plan Transaction No.: Page 1 Index and title ~~,,~r~y#1it't11!it8o~,tr/ Page 2 Data entry r.e> ~0Page 3 Mound drawings a°".~ Page 4 Lateral and dose tank Page 5 System maintenance specifications • • B'+A r_I Page 6 Management and contingency plan 19' - Page 7 Pump curve and specifications 129 Page 8 Plot plan t R s Lam:' W1 %Z IG */k/rrrrrn111111►tti Designer: Mary Jo Huppert License Number: 1859 - 007 Date: 08/30/16 Phone Number: 715 - 426 - 1775 Signature: 1 I 'S ~Ll Iy 4 6 Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01/01), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01) Version 7.0 (R. 03/2012) Page 1 of 8 r %u f) Mound and Pressure Distribution Component Design Site Information R Residential or Commercial Design Note: Sand fill (D) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 383-44-3 in-situ soil treatment for 1.50 Peaking Factor (e.g. 1.5 = 150%) fecal coliform of 36 inches. 450.00 Design Flow (gpd) 3.00 Site Slope 98.75 Contour Line Elevation (ft) 18.00 Depth to Limiting Factor (in) 0.40 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 45.00 Dispersal Cell Length Along Contour (ft) = 10.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution L Y Pressure Disribution Information network? Enter Y or t. e Center or End Manifold 3.33 Lateral Spacing (ft) If N above, enter the elevation ft 3 Number of Laterals of the highest point. 0.156 Orifice Diameter (in) 3.50 Estimated Orifice Spacing (ft) = 11.54 ft2/orifice 2.00 Forcemain Diameter (in) 118.00 Forcemain Length (ft) Does the forcemain drain back? Y 87.00 Pump Tank Elevation (ft) Enter V,)r 4.55 System Head (ft) x 1.3 19.25 Forcemain Drainback (gal) 12.84 Vertical Lift (ft) 41.63 5x Void Volume (gal) 1.18 Friction Loss (ft) 60.88 Minimum Dose Volume (gal) I 0.00 In-line Filter Loss (ft) 21.00 System Demand (gpm) 18.57 Total Dynamic Head (ft) / Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x x 1.00 x 1.50 x 1.25 x x 2.00 1.50 x 3.00 2.00 x 3.00 x Gallons/Inch Calculator Treatment Tank Information Total Tank Capacity (gal) 1000.00 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Wieser Manufacturer gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 600.00 Dose Tank Capacity (gal) Pol Lok Filter Manufacturer 17.76 Dose Tank Volume (gal/in) Filter Model Number Weiser Manufacturer I Z Project: DAVID L. & MICHELE K. LEE Page 2 of 8 Mound Plan and Cross Section Views t 1/108 J : : Observation Pipe : : • . T ' j K tltA -T Q A WT B I: - L Mound Component Dimensions Down slope toe extension made. A 10.00 ft E 21.60 in H 1.00 ft K A32. ft B 45.00 ft F 9.25 in z 15.00 ft L ft D 18.00 in G 0.50 ft J 7.63 ft W ft 450.00 (ft2) Dispersal Cell Area 1125.00 (ft2) Basal Area Available 10.00 (gpd/ft) Linear Loading Rate 4.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 102.02 (ft) ♦ H //ff/i!F!!!.r/! ..!!F!! !f! ! f/ /!!f!/1 F 100.25 (ft) ! Dispersal Cell 100.75 (ft) Lateral Invert Dispersal Cell Elevation E p `9`8.75 (ft) Contour Elevation 3.0 % Site Slope Geotextile Fabric Cover Shading Key o a Dispersal Cell See lateral details on Q Topsoil Cap c a 1.5 ft Page 4 for number, size, 2Q rfl r,,, Subsoil Cap FA o Q5 and spacing of laterals. ASTM C33 Sand c d Laterals are equally Tilled Layer y 0.5 ft Tvpical Lateral F spaced from the © Aggregate v c u distribution cell's centerline in the A distribution cell (AxB). Project: DAVID L. & MICHELE K. LEE Page 3 of 8 End Connection Lateral Layout Diagram Center the laterals over the A & B dimension Turn-up r'Gall .ra lva or clan cut plug oles d All laterals are identical IE X ES-h rilled on the bottom of the lateral qually spaced Laterals aforcemain 0 PVC per SPS Table 384.30-6 5 Force main connection via tee or cross to manifold at any point. Number of Laterals 3 Orifice Diameter 0.156 in Lateral Diameter 1.25 in Orifice Spacing (X) 3.63 f! Lateral Length (P) 43.56 ft Orifices per Lateral 13 Lateral Spacing (S) 3.33 ft Orifice Density 11.54 ii urlilce Lateral Flow Rate 7.00 gpm Manifold Length 6.67 ft System Flow Rate 21.00 gpm Manifold Diameter 1.25 in Total Dynamic Head 18.57 ft Forcemain Velocity 2.14 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and SPS 316.300 WAC 4 in. min. Disconnect 1_ Tank component is property vented F- Alternate outlet location - - Forcemain diameter Weiser Manufacturer 2 in Ca acit 600.00 Gallons T Volume 17.76 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 17.46 310.02 B 2.00 35.52 C C 3.43 60.88 Pump off elevation (ft) D 10.90 193.58 87.91 Total 33.78 600.00 D Dose tank elevation (ft) 3" Bedding under tank. 87.00 Alarm Manuafacturer SJE Rhombus Note: Switch(_ Alarm Model Number Tank Alert AB containing mel r. may not be t~_= Pump Manufacturer Gould Pump Model Number PE 41 Pump Must Deliver 21.00 gpm at 18.57 ft TDH Project: DAVID L. & MICHELE K. LEE Page 4 of 8 Mound System Maintenance and Operation Specifications Service Provider's Name parrell's Septic Service Phone 715-425-1025 POWTS Regulator's Name - St. Croix County Zonin Phone, 715-386-4680 1 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank =shhouldd /or service once eve 3 ears Effluent Filter d clean at least once eve 3 ears Pump and Controls st once eve 3 ears Alarm hould test month) Pressure System hed and ressure tested eve 1.5 ears Mound an d seepage once eve 3 years Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished • . Grade \ 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lon Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: DAVID L. & MICHELE K. LEE Page 5 of 8 Mound System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with SPS 382-84 W is. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01/01), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 383.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution Svstem No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BODS, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS, 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the pen-nit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. If the septic tank or any of its components become defect Contin ive the tank o cPlan omponent shall be repaired or replaced to keep the system in proper operating condition. It the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project:{y'I D L.. N1t C}tE K . LEE Page 6 of 8 Wastewater - _ METERS FEET 40 PE51 - MODELS: PE31, PE41, PE51- - 35 ; -HP:.33, .40, .50 10 2 GPM x 30 PE o FT = 25 PE31, .5-7 20 15 O 5 0 00 10 60 70 GPM 80 30 40 50 0 5 10 15 m3/h CAPACITY PERFORMANCE RATINGS PE31 PE41 Total Head PE51 (feet of water) GPM (feet of water) GPM Total Head MM8 5 52 $ 10 42 10 61 15 29 15 57 20 16 20 46 25 0 25 16 33 i~AF,F-3 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ✓VA 1 C ff E L C Z- EE Mailing Address 3 6.4 -VEr,~ 4 Lb &J, - r-4 7 5:t - V7~sc Property Address 7 (Verification required from Planning & Zoning Department for new cons Mction.) City/State "OAL P L+~ Parcel Identification Number LEGAL DESCRIPTION C' Property Location .J W/4 ,1<10 Sec. T ~N R_/&_W, Town of Subdivision Plat: Lot # Certified Survey Map # Zt1 j j Volume Page # Warrantv Deed # 3 (before 2007)Volume 55 (,Page # Spec house :1 yes G no Lot lines identifiable C yes ❑ no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on is form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a rranty deed recorded in Register of Deeds Office. Number of bedrooms SIGNATURE OF APPLICANT(S) DATE * * *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) Plot Plan for Site and S'oil` Evalnadon Page ~ of $ Property Owner' _bAN1ZJ ~ A tcttsC~-- Lp-r~ s Legal DeSMPdon AW 1/4 aF Tu e aj`/gF s, ~L (accept where noted) T70,Ajt 3 6F BA= wiu - sa; _ Backkoe pt t s t PI 0.1 -A; b VS* SA60 n ~g r - t 49.ob 5.53: 00/ s , IZ?~ po N 0PI, N _ U Ck FtP-ua 10 t a r) VJELL- -To Site I,ocadon. > _7S, To _S PT C `Tf! nl !td VE. -k l SEC. Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Ms. Adm. Code Attach complete site plan on pa County ST. CROIX p per not less than 8112 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parccedl I (P7endinF .0 Please print all information. R viewre Date Personal information you provide may be used for secondary . 15.04 - -7 Property Owner ® ) Property oca ocatlon ❑ DAVID L.,& MICHELLE K. EE vt. Lot NW 1/4 NW 1/4 s 10 T 29 N R 16 E (or) W Property Owner's Mailing Address Lot # ock # Subd. Name CSM# C 2409 110th Avenue ly, G L-0 TS ( iii iy i kY State Zip Code Pho Woodville, WI 54028 ( ~1-ANNWC &xC Village ■ Town Nearest Road 240th Street New Construction UseEj Residential / Number of bedrooms 4 Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material sandv outwash Flood Plain elevation if applicable General comments 111 ft. a mmendappoons ,n Mound System 1.25 ft. sand fill 0.6 loading rate 4S Qhe v l fj, I~ to cu~2c~ > 60 ~ i'►L~vyel ~p r'►~,%jti ee test dated 06-24-09. Lot to be split using previous test data. f a pow er l s Q a UZ~7, Boring # ❑ Boring Q Pit Ground surface elev. 100.79 ft. Depth to limiting factor 31 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-4 7.5YR3/2 1 3fgr mvfr cb 3vf-co 0.6 0.8 2 4-9 7.5YR3/2 1 Zfa&sbk mvfr aw 2vf-co 0.6 p.g 3 9-16 10YR4/4 sil 2fabk mfr aw 2vf-m 0.6 0.8 4 16-31 7.5YR4/6 sl 2f-mabk nfr as Zvf-m 0.6 1.0 5 31-47 7.5YR4/6 c2d 5YR5/6 sl 0m mf 1vf-f 0.2 0.6 Some gr; few cobs. 3 Boring # ❑ Boring 99.59 El Pit Ground surface elev. ft. 30 Depth to limiting factor in. Soil Wawok Application Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Rate in. Munsell Qu. Sz. Cord. Color Gr. Sz. Sh. #2 1 0-9 10YR2/2 I 3f-mgr mvfr 8 2 9-15 10YR3/2 1 3fa&sbk ds 8 3 15-24 7.5YR4/4 sil Zf-msbk dsh 8 4 24-30 7.5YR4/6 - sl if--msbk ds aw Zvf-f 0.4 0.7 5 30-44 5YR 4/6 c2d 2.5YR4/6 A Om mfr lvf-f 0.2 0.6 Some gr; few cobs & stones. * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30< 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS < _ 30 mg/L CST Name (Please Pnrtt) - _ Number tore CST Ntxnber M Jo Hu rt ollister s Soil Testln & Desi (,1 Address 224832 Date Eva Conducted Telephone Number W9875 690th Avenue, River Falls, WI 54022 06 - 24 - 09, 05 - 22 &06 - 24 - 10 (715) 426 - 1775 h " Property Owner LEE, David & Michelle (South Lot) Parcel ID # (Pending) page 2 of 3 Boring # ❑ Pit Boring Ground surface elev. 98.99 ft. Depth to IKniting factor 21 • in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Stare Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-6 10YRZ/2 I 3fgr mvfr cb 3vf-co 0.6 0.8 2 6-10 IOYRZ/2 - 1 2fsbk mvfr aw 2vf-c0 0.6 0.8 3 10-14 1OYR4/4 _ I 2fa&sbk mvfr cW 2vf-m 0.6 0.8 4 14-21 7.5YR4/4 1 Zfabk mfr cw 2vf-m 0.6 0.8 5 21-24 7.5YR4/4 flf 7.5YR4/6 sl if--msbk mvfr cw 2vf-f 0.4 0.7 6 24-3Z 7.5YR4/6 flf 7.5YR5/6 sl Om mfr lvf-f 0.2 0.6 Some gr, few cobs. Boring # ■ Boring 1-11 99.25 18 Pit Ground surface elev. ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Struchrre Consistence Boundary Roots GPD/fl? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-5 10YRZ/2 1 2fabk mvfr 0.6 0.8 2 5-9 I 2/Z - 1 2fsbk mvfr - 0.6 0.8 3 9-13 IOYR4/4 sl 2fsbk mvfr - 0.6 1.0 4 13-18 7.5YR3/4 sl 1 f-msbk mvfr 0.6 1.0 5 18-22 7.5YR3/4 f1f 7.5YR4/6 sl Om mfr 0.2 0.6 Some gr. Boring a Boring # Pit Ground surface elev. ft. Depth to limiting factor in. Sod ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDhT in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *E1f#2 Awl,a. Effluent #1 = SODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-6330TeR (807/00) R Plot Plan for Site and Soil Evaluation Page 3 of 3 Property Owner bm kz, L. t t_ ~:-,O L)_7 ti L-O-~ I 40 ft. Legal Description Nw '/y OF TH E A,,,`/(4 st (except where noted) N~ R I L~ W , s oi,J nr l3-A Lt, U) I e Backhoe pit 0- "7-at} pp- 0PC EO ✓ tic North ! ! s Al E ~~~,o~ ~a1 a Vt) ~ ` q9 sq' S ~,Oo~ V r+~' t 2Q-0, L'AJ Rau ~S~Lj, Q I ~ ~I i Site Location: } S 4R _ t~ Wisconsin Department of Commer SOIL EVALUATION REPORT Page I of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County ST. CROIX Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. (Pending) percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. evie Y Date -7 Personal information you provide maybe used for secondary purposes (Privacy L 15.04 (1) (m)). Property Owner EIv~D operty Location ❑ ❑ DAVID L. & MICHE K. G vt. Lot NW 1/4 NW 1/4 S 10 T 29 N R 16 E (or) W Property Owner's Mailing Address L # Block # Subd. Name CSM# 2409 110th Ave e - (Pending) kA "4 ? City State Zip Code Phc ber COVNr( ity ~ Village Town est Road Woodville, WI 54028 ~T cRUIN Gar C 240th Street New Construction Llse>] Residential / N r of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe: Parent material _oA ~ sa y outwash Flood Plain elevation if applicable NA ft. General comments / Q Mound System 1.25 ft. s d fill 0.6 loadi rate and recommendations: g / ~G !Jy' ~U[/t / < v'( QTR ~O~ Q~ L° /~1T! >t cQ~1~ wl/ ~T rna h A See test dated 06-24-09 Lnt o be split using previous test data.CJ a Boring # ❑ Boring l/ 1~ ~0 G~✓ ~C7b7~1/L Q Pit Ground surface elev. 100.79 ft. Depth to limiting factor 31 in.h Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-4 7.5YR3/2 1 3fgr mvfr cb 3vf-co 0.6 0.8 2 4-9 I 2fa&sbk mvfr aw 2vf-co 0.6 0.8 ,LZ f 3 9-16 I OYR4/4 sil 2fabk 0.8 mfr aw 2vf-m 0.6 4 16-31 7.5YR4/6 A 2f-mabk mfr as 2vf-m 0.6 1.0 5 31-47 7.5YR4/6 c2d 5YR5/6 sl Om mfi lvf-f 0.2 0.6 Some gr; few cobs. a Boring # ❑ Boring 99.59 G4 30 pyL P'ti~a~ JG2Cl/ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-9 1OYR2/2 I 3f-mgr mvfr cb 3vf-co 0.6 0.8 2 9-15 10YR3/2 I 3fa&sbk ds ate' 2vf-co 0.6 0.8 3 15-24 7.5YR4/4 sil 2f-msbk dsh aw 2vf-m 0.6 0.8 4 24-30 7.5YR4/6 sl If--msbk ds aw 2vf-f 0.4 0.7 5 30-44 5YR4/6 c2d 2.5YR4,/6 sI Om mfr l of-f 0.2 0.6 Some gr; few cobs & stones. ' Effluent #1 = BOD, > 30:< 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) t re CST Number Ma Jo Hu ert Hollistees Soil Testing & Design) 224832 Address Date E at on Conducted Telephone Number W9875 690th Avenue, River Falls, WI 54022 06 - 24 - 09 & 05 - 22 - 10 (715) 426 - 1775 iL rls - Property Owner LEE, David & Michelle (South Lot) Parcel ID (Pending) 2 3 # Page of ❑ Boring # Boring Ground surface elev. 98.99 Pit ft. Depth to limiting factor 21 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 1 0-6 IOYR2/2 1 3fgr mvfr cb 3vf-co 0.6 0.8 2 6-10 10YR2/2 1 2fsbk mvfr aw 2vf-co 0.6 0.8 3 10-14 10YR4/4 ( 2fa&sbk mvfr cw 2vf-m 0.6 0.8 4 14-21 7.5YR4/4 1 2fabk mfr cw 2vf-m 0.6 0.8 5 21-24 7.5YR4/4 fl f 7.5YR4/6 sl 1 f-msbk mvfr cw 2vf-f 0.4 0.7 6 24-32 7.5YR4/6 fl f 7.5YR5/6 A Om mfr 1 of--f 0.2 0.6 1 1 Some gr; few cobs. ❑ Boring # 11 Boring n Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 xo Boring # Boring ❑ ❑ Pit Groun 7 /R16?d /nury~ in. Horizon Depth Dominant Color Soil Application Rate 7~O U~ nce Boundary Roots GPD/ff in. Munsell *Eff#1 *Eff#2 j - * Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330Test (R.07/00) Plot Plan for Site and Soil Evaluation Page 3 of 3 Property Ownerv Syr 19Y =40fz Legal Description Nw '/4 (except where noted) A,a or T3-A L A) Q= Backhoe pit North & C~ c31 , (,Pep 100,00 Q' ASSt1 K: l~~ 0~~~ ~ ~ r.rtr?VtN~ ~ZILP;Pq rN W i t Site Location: ,Q -4A a ~ •.r,12,4y l Plot Plan for Site and Soil Evaluation 'age 3 of 3 Property owners Lee I"=4oft. Legal Description (except where noted) --T. ELM' =Backhoepit t 4 r~~ rc - 7Ro~o. tb P4-,Vz North r" r b3z q ~O EIY 9p.~a a o K e~oYd w, 5 C~rnvly rs HEM c"~..~( .P~ 2l~Cae~ ~'t 1Nt S ~ v fi ~?YES ~ _ pse~ GSA d,~-~ i~-~- 5-/ l D 2- Site Location. /rDfti>4ut. ~ o sic. ty K Parcel 002-1020-90-500 03/02/2012 04:03 PM PAGE 1 OF 1 Alt. Parcel M 10.29.16.141 E 002 - TOWN OF BALDWIN Current [X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 08/09/2010 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner 0 - LEE, DAVID L & MICHELE K DAVID L & MICHELE K LEE 2409 110TH AVE WOODVILLE WI 54028 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 240TH ST SC 0231 SCH D BALDWIN-WDVILLE 1077 240TH ST SP 1700 WITC Legal Description: Acres: 6.930 Plat: 5721-CSM 24-5721 002/2010 SEC 10 T29N R1 6W PT NW NW & PT SW NW; Block/Condo Bldg: LOT 05 FKA CSM 14/3957 LOT 1 (20.000AC) NKA CSM 24-5721 LOT 5 (6.930AC) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 10-29N-16W NW NW 10-29N-16W SW NW Notes: Parcel History: NEW FOR 2011; TAKES ALL 002-1020-90-100 Date Doc # Vol/Page Type (141A) FOR CSM 24-5721; LOT 3 08/09/2010 920351 24/5721 CSM 002-1030-90-300 (141 C) LOT 4 (141 D) 05/11/2004 762196 2569/58 EZ-U 002-1030-90-400 & LOT 5 (141 E) 10/16/2000 631890 1551/235 WD 002-1030-90-500 09/27/2000 630592 14/3957 CSM 2011 SUMMARY Bill M Fair Market Value: Assessed with: 132999 Use Value Assessment Valuations: Last Changed: 04/06/2011 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 4.000 800 0 800 NO 00 UNDEVELOPED G5 0.400 100 0 100 NO 00 AGRICULTURAL FOREST G5M 2.530 4,300 0 4,300 NO 00 Totals for 2011: General Property 6.930 5,200 0 5,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Department of Safety and Professional Services Division of Industry Services 501E EVALUATION REPORT Page 1 of 2 in accordance with SPS 383, Wis. Adm. Code County ST. CROIX Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 002 - 1020 - 90 - 500 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location DAVID L. & MICHELE K. LEE Govt. Lot NW 1/4 NW 1/4 S 10 T 29 ' N R 16 E (or) Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 304 6th Avenue 5 CSM 24-5721 City State Zip Code Phone Number ity Village ■ Town Nearest Road Baldwin, WI 54002 ( 715) 760 - 0822 240th Street El New Construction User Residential/ Number of bedrooms 3 Code derived design flow rate 450 GPD ❑ Replacement Public or commercial - Describe: Parent material loess over till Flood Plain elevation if applicable NA ft. General comments Mound S stem ;ft 0.4 loadin rate and recommendations: y g Additional boring to extend area. 6❑ Boring # 11 Boring Q pit Ground surface elev. 99.06 ft. Depth to limiting factor 18 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Ef1#1 'Eff#2 1 0-6 IOYR2/2 I 3fa&sbk mvfr 0.6 0.8 2 6-16 10YR3/2 sil 2fabk mr 0.6 0.8 3 16-18 IOYR4/4 - Sill Ifabk mfr 0.6 0.4c 4 18-20 IOYR4/4 cld IOYR4/6&10YR6/2 mfr sil 1 fabk 0.4c 0.6 0 Boring # ❑ Boring Q Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots GPDiff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30:< 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOO < 30 mg1L and TSS < 30 mg/- CST Name (Please Print) Signature ~y CST Number MARY JO HUPPERT Hollister's Soil Testin &Desi n 224832 Address ate Evaluation Co ed Telephone Number W9875 690th Avenue, River Falls, WI 54022 09 - 27 - 2015 715-426-1775 SBD-8330 (1107/13)